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Editor's quiz: GI snapshot
Large serrated tongue and gastrointestinal bleeding
  1. Abdul Rehman1,
  2. William L Peterson2,
  3. Jatinder P Ahluwalia1
  1. 1Gastroenterology and Hepatology, Department of Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
  2. 2Gastroenterology, Springfield Clinic, Springfield, Illinois, USA
  1. Correspondence to Dr J P Ahluwalia, Gastroenterology and Hepatology, Department of Medicine, Southern Illinois University School of Medicine PO Box 19636 Springfield, IL 62794-9636 USA; jahluwalia{at}siumed.edu

http://dx.doi.org/10.1136/gut.2009.185843

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    Question

    A 60-year-old man with history of diabetes mellitus, chronic renal insufficiency, hypertension and multiple myeloma diagnosed 1 year ago presented with new onset crampy abdominal pain and tarry black stools. He had been receiving treatment with Bortezomib. His vital signs were normal except for the blood pressure that was 146/82 mm Hg. Physical examination revealed a thick, serrated tongue with very prominent impression of teeth (panel A), mild lower abdominal tenderness without any rebound and melenic stool in the rectum. Laboratory studies showed a haemoglobin of 10 g/dl, serum creatinine …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.